Melatonin and postoperative delirium: a possible link?

Yousaf, Farhanah; Seet, Edwin; Venkatraghavan, Lashmi; Katznelson, Rita; Chung, Frances

doi:10.1007/s12630-010-9340-2

Cited by 4 publications

(3 citation statements)

References 7 publications

(8 reference statements)

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“…Väčšina rizikových faktorov v tejto klinickej štúdii predstavovala nemodifi kovateľné rizikové faktory, a práve z tohto dôvodu je vhodné zvážiť nové stratégie prevencie, akými sú napr. predoperačné podanie melatonínu [38] či perioperačná aplikácia dexmedetomidínu [39], ktoré by mali byť u kardiochirurgických pacientov preskúmané, a v prípade pozitívnych výsledkov aplikované do praxe za účelom zníženia incidencie pooperačného delíria.…”

Section: Záverunclassified

Incidence and risk factors of delirium in patients after cardiac surgery: Modifiable and non-modifiable factors

et al. 2015

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Predmet výskumu: Delírium po kardiochirurgických operáciách predstavuje závažnú komplikáciu. Klinická štúdia mala za úlohu posúdiť včasné rizikové faktory delíria a identifi kovať, ktoré z nich by mohli byť potenciálne modifi kované za účelom optimalizovania perioperačného manažmentu. Metodika: Pôvodná práca predstavuje prospektívnu klinickú observačnú štúdiu. Štúdia pozostáva z 250 po sebe nasledujúcich pacientov. Operačné postupy, spôsob vedenia anestézie ako aj pooperačný manažment pacientov boli realizované štandardným spôsobom. Incidencia a rizikové faktory pooperačného delíria boli analyzované v prvom kroku použitím analýzy s jednou premennou. Premenné považované za klinicky významné boli následne použité v analýze s viacerými premennými za účelom identifi kovania nezávislých rizikových faktorov delíria. Prítomnosť delíria bola hodnotená pomocou skórovacej škály-The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)-každých 12 hodín po operácii. Výsledky: Pooperačné delírium sa rozvinulo u 52 pacientov (20,8 %). Analýza s použitím jednej premennej potvrdila, že pokročilý vek (p = 0,0001), vyššia hodnota EuroSCORE II (p = 0,0001), dlhšie trvanie mimotelového obehu (p = 0,0001), dlhšie trvajúce naloženie aortálnej svorky (p = 0,0001) a dávka sufentanilu (p = 0,010) boli signifi kantne asociované so vznikom pooperačného delíria. Podávanie benzodiazepínov sa ukázalo ako intermediárny prediktor pooperačného delíria (p = 0,055). Zhrnutie: Pokročilý vek, vyššia hodnota EuroSCORE II, dlhšie trvanie mimotelového obehu a dlhšie naloženie aortálnej svorky, vyššie dávky sufentanilu podané v priebehu anestézie predstavujú všetko rizikové faktory vzniku pooperačného delíria. Jediným modifi kovateľným rizikovým faktorom pooperačného delíria bola dávka podaného sufentanilu, ktorá súvisela s dĺžkou trvania samotnej operácie. Nové preventívne stratégie a podanie nižšej dávky sufentanilu počas samotnej operácie, ako aj použitie iných opiátových prípravkov by malo byť preskúmané a v prípade priaznivých výsledkov aplikované do praxe za účelom zníženia výskytu pooperačného delíria.

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Incidence and risk factors of delirium in patients after cardiac surgery: Modifiable and non-modifiable factors

et al. 2015

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“…Although some previous studies have shown connections between melatonin secretion disruption and delirium, few have elucidated the real melatonin rhythm pattern. [43][44][45] For example, a prospective observational study by Yoshitaka et al 46 showed that the delta plasma melatonin concentration (calculated based on the preoperative and postoperative values at selected time points) at 1 hour after surgery was significantly lower in patients with than without delirium. Melatonin secretion exhibits a biphasic pattern in which daytime secretion is low (5 pg/ mL on average), and night-time secretion is relatively high (50-100 pg/mL).…”

Section: Discussionmentioning

confidence: 99%

Effects of general versus regional anaesthesia on circadian melatonin rhythm and its association with postoperative delirium in elderly patients undergoing hip fracture surgery: study protocol for a prospective cohort clinical trial

et al. 2021

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IntroductionPostoperative delirium (POD) is a common neurological complication after hip fracture surgery and is associated with high morbidity and mortality in elderly patients. Although the specific mechanism of POD remains unclear, circadian rhythm disruptions have recently drawn increased attention. To date, only limited postoperative time points of plasma melatonin level measurements were recorded in previous studies, and such data cannot represent a comprehensive melatonin rhythm. The process of anaesthesia (either general anaesthesia (GA) or regional anaesthesia (RA)) is known to influence the melatonin rhythm. However, how these two anaesthesia methods differently affect the postoperative melatonin rhythm is still unknown. Therefore, we hypothesise that RA may attenuate the disruption of the melatonin rhythm, which might decrease the incidence of POD in elderly patients undergoing hip surgery.Methods and analysisIn this prospective cohort clinical trial, 138 patients scheduled for hip fracture surgery will be divided into two groups to receive either GA or RA. The primary aim is to compare the circadian rhythm of melatonin secretion between the two groups and explore its association with the incidence of POD.Ethics and disseminationThe study has been approved by the Medical Science Research Ethics Committees of Beijing Jishuitan Hospital (JLKS201901-04). The results of the study will be published in peer-reviewed international journals.Trial registration numberChiCTR1900027393.

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“…Whether reduced levels of melatonin play a similar role in POCD in elderly subjects or AD patients is a crucial issue regarding perioperative management. Unfortunately, to date, few clinical and experimental studies have explored this issue . Therefore, we have been suggested that melatonin pre‐treatment may ameliorate cognitive dysfunction after isoflurane anaesthesia.…”

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confidence: 99%

Melatonin Attenuates Isoflurane‐Induced Acute Memory Impairments in Aged Rats

Liu

Tang

et al. 2013

Basic Clin Pharma Tox

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Abstract:Melatonin is an endogenous hormone with neuroprotective effects. Melatonin levels in elderly patients are reduced after surgeries that require anaesthesia. Whether reduced melatonin levels are important for postoperative cognitive dysfunction (POCD) remains unclear. Here, we investigated the effects of melatonin on cognitive dysfunctions induced by isoflurane and mechanisms underlying these effects. Seventy-two 20-month-old Sprague-Dawley rats were randomly divided into six groups (n = 12). These groups included M1 and M10 groups that received intraperitoneal melatonin at 1 mg/kg or 10 mg/kg, respectively, and an ISO group that received 4 hr of inhaled 2% isoflurane. They also included M1+ISO and M10+ISO groups that received 1 mg/kg or 10 mg/kg of melatonin plus 4 hr of inhaled 2% isoflurane, respectively, and a control group that received an equal volume of saline. Injections were administered daily for 14 consecutive days. Memory was assessed in the Morris water maze. Plasma and hippocampi were harvested to determine melatonin concentrations and MT1/MT2 receptor expression. Rats treated only with isoflurane showed significantly longer latencies in Morris water maze test trials compared with the control group, with shorter time in the probe trial (p < 0.05). Although plasma melatonin levels and MT2 expression in the hippocampus were significantly decreased, MT1 expression was higher in the isoflurane group than in the control group (p < 0.001). However, these parameters did not significantly vary in animals administered melatonin compared with controls. Isoflurane may induce cognitive dysfunction by influencing melatonin and MT1/MT2 levels. Melatonin can improve cognitive dysfunction by normalizing plasma melatonin and its receptor levels.

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Melatonin and postoperative delirium: a possible link?

Cited by 4 publications

References 7 publications

Incidence and risk factors of delirium in patients after cardiac surgery: Modifiable and non-modifiable factors

Incidence and risk factors of delirium in patients after cardiac surgery: Modifiable and non-modifiable factors

Effects of general versus regional anaesthesia on circadian melatonin rhythm and its association with postoperative delirium in elderly patients undergoing hip fracture surgery: study protocol for a prospective cohort clinical trial

Melatonin Attenuates Isoflurane‐Induced Acute Memory Impairments in Aged Rats

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